Reflective practice across speech and language therapy and education: a protocol for an integrative review

Effective co-practice is considered a linchpin of inclusive education. Speech and language therapists (SLT), in collaboration with teachers, are amongst the professionals who have a role in ensuring inclusion for students. The challenges of collaboration are well documented, with communication considered a potential antidote. Proposals for how collaborative communication can take place often align with models of reflection. Uncertainty around a shared language for reflection within and across the professions of teaching and SLT may pose a barrier to it occurring. Reflection has long been documented as a strategy used by effective clinicians to improve practice. Hence, teachers and SLTs reflecting together could be considered ‘a port of entry’ for effective collaborative practice. This study aims to synthesise literature and knowledge on the phenomenon of reflective practice across the professions to facilitate collaboration for inclusive education. The method of qualitative evidence synthesis will be an integrative review. A systematic search will be conducted to extract empirical studies, reviews and theoretical papers on the topic of reflection across both professions. An adapted version of the PRISMA reporting guidelines will be used in the development, design and reporting of this review. Four databases will be searched: CINAHL, SCOPUS, Education Source and ERIC. A web-based search will also be conducted to retrieve relevant policy documents. Included literature will be appraised using the M-MAT and an adapted checklist from the Joanna Briggs Institute. Deductive content analysis will endeavour to determine if a shared language exists about reflection, across the professions of teaching and speech and language therapy. Establishing a shared language represents a first step towards the development of a framework for collaborative reflection between teachers and SLTs. This is turn serves to inform future research, policy and practice regarding how speech and language therapist can work collaboratively with teachers in schools.


Introduction
The need to work towards inclusive education for all was recognized internationally with the publication of the Salamanca Statement (UNESCO, 1994).Effective co-practice between a variety of professionals is proposed as a means by which inclusive education can be achieved and is a term used generally in situations where staff from different professions work together (McKean et al., 2017).In professional policy (ASHA, 2001;RCSLT, 2018;SPA, 2011) and the literature (Law et al., 1999;McCartney, 1999;McCartney, 2000;McCartney, 2002) speech and language therapists (SLT) are recognised as some of the professionals who play a crucial role in the implementation of practical and strategic changes, to ensure inclusion is the norm for students with speech, language and communication needs (SLCN) in schools (Ebbels et al., 2019;McKean et al., 2017).The response to this in some countries has been the provision of SLT services as part of the education system; however, the specifics of facilitating effective collaboration between SLT's and teachers working together in practice remains limited (Gallagher et al., 2019).What is clear, is that co-practice is challenging, and it is hard to work together, particularly in inter-professional contexts.
Literature from the 1990s onwards outlines what makes co-practice so difficult.Developing reciprocal relationships (Field, 2003), establishing shared language (Law et al., 2001) and managing power dynamics are just some of the factors that can influence the effectiveness of co-practice between individuals.Another challenge, unique to the therapeutic and pedagogical co-practice context, is the many forms that co-practice in a school can take.Suleman et al. (2014) has proposed frameworks that detail the ways in which teachers and SLT can work together, classifying a transdisciplinary model as the most integrative.Transdisciplinary co-practice is distinctive from others due to the professional overlap (Hall & Weaver, 2001) in addition to the sharing of roles and responsibilities.Striving to work together effectively in this way requires the recognition of a potential threat to professional identity (Binyamin, 2017).
Communication is proposed as a potential solution to the challenges experienced.In the literature, this communication is characterised by an ongoing dialectal process (Bleakley & Bligh, 2008) that facilitates careful consideration of self, others, experiences and changes (Mackey, 2007).Aligned with Mackey's proposal of 'careful consideration' are definitions of reflection and models of reflective practice.Boud et al. (1985) stated that reflection is 'a conscious activity' that can be engaged with to explore experience and understand better."Reflective practice is the act of reflection, captured in some way (discussion, writing), on a systematic basis" (CIPD, 2020:3).It is a requirement for the development of new skills as well as developing the responsive capacity of a person to create productive relationships, manage emotions, make decisions and cope with stress (CIPD, 2020).It is therefore considered particularly useful in dealing with difficult or challenging situations (Moon, 1999).Models and frameworks exist that facilitate reflective practice in professional contexts.For example, Dr Stephen Brookfield's Lens Theory (1995) is frequently cited in relation to teaching as a means of supporting the professional reflection of teachers, while the Reflective Theory Model of Argyris & Schӧn (1978) has been quite influential in the field of SLT (Caty et al., 2015).Reflective practice is regarded as essential to the professional role (Finlay, 2008).Despite its centrality to both professions there has been remarkably little research into the reality of how it is used by practitioners (Bray, 2020).Publications in the fields of nursing, teacher education, social care as well as across other medical professions (Boud, 2010) most often refer to the use of reflective practice with higher education students or as part of CPD.
As outlined, integrative co-practice between SLTs and teachers in schools continues to be novel and can pose a threat to professional identity.Finlay stated generally that engaging in reflective practice often forms the "bedrock of professional identity" (2008:3).Thus, the use of reflection by teachers and SLTs may be valuable in the attempt to forge new identities within a novel working context.
A potential difficulty is that across different disciplines and intellectual traditions, what is understood by 'reflective practice' varies considerably (Fook et al., 2006).In order to facilitate collaboration of any kind, there is a need for a shared language (Law et al., 2001).Therefore, a shared or common language for reflection must be identified if successful co-reflection between the two professions is to be considered.Reflecting together is not only required to ensure effective co-practice but also to facilitate the transition from an individual profession working comfortably in their own field to an integrative team member working clinically in the educational context.However, "the gap between the 'high ground' of theory and the 'swampy lowlands' of practice" (SkillsYouNeed, 2020) remains relatively unexplored.An initial overview of literature, policy and practice would indicate that thus far methods for reflecting together, outside of the IPE context, are at best underutilised if not completely underdeveloped.There therefore exists a need for exploration, with the literature as the first point of reference.By interrogating the literature in this research study, we hope to determine if a shared understanding of reflective practice exists between health and education.
The question guiding this research is: How is reflection understood across the professions of SLT and teaching?
The principle aim of this study is to synthesise literature and knowledge on the phenomenon of reflective practice across the professions of speech and language therapy and teaching.This will be achieved by addressing four objectives: (i) What is common or shared about the understanding of reflective practice across both professions?
(ii) What is different about the understanding of reflective practice across both professions?
(iii) What implication do these commonalities and differences have for collaborative practice between SLTs and teachers?
(iv) What remains unknown or needs to be investigated for collaborative reflection between the professions?
Addressing these objectives will provide insight into the value placed on reflection by both professions as well as determining the language and terms used to describe reflection and reflective practices across disciplinary contexts.New knowledge from this research can be used to inform the development of a framework to guide collaborative reflective practice between teachers and SLTs.This knowledge will be relevant to those in practice, research, management and policy development, working towards truly collaborative interdisciplinary relationships as part of an inclusive education system.

Protocol
This protocol is reported in line with the Preferred Reporting Items for Systematic review and Metal-Analysis Protocols (PRISMA-P) checklist (McCluskey et al., 2021).An integrative review (Kirkevold, 1997) has been chosen as the method for this study.This is a method that allows the integration of different types of knowledge about practice-based questions.
It involves identifying, analysing and synthesising a diverse range of literature sources; empirical, theoretical and policy.
It is considered an effective method to guide evidence informed practice (Crawford & Rondinelli, 2013).In this study we propose to use Souza et al.'s (2010), framework for conducting integrative reviews.This framework incorporates six phases: preparing the guiding question, searching and sampling the literature, data collection, critical analysis of the studies included, discussion of results and finally the presentation of the integrative review.Suri (2019) outlined ethical considerations when conducting a systematic review, which will also be contemplated across all six phases of this integrative study.

Preparing the guiding question
The research question and objectives above have been created based on practice knowledge and exploration of the literature.The question is specific to speech and language therapy and education in order to capture the literature pertaining to reflective practice in these fields only.Identification of additional research questions and objectives may be an iterative process, informed by continued immersion in the literature while conducting this review.

Searching and sampling
Sampling strategies.The first search strategy will be a systematic search of published, peer-reviewed literature.A comprehensive, systematic search will be conducted to extract empirical studies, reviews and theoretical papers from electronic databases.The choice of databases was informed by preliminary searches and will be confined to CINAHL, SCOPUS, Education Source and ERIC.In order to ensure key literature is not missed, noteworthy references from papers retrieved will also be traced using a snowballing (Webster & Watson, 2002) technique.Literature will also be obtained by hand searching reference lists of included articles.The second search strategy will be a manual web-based search.This search will include the websites of professional organisations and publications from government-based reports and guidelines.This will ensure a comprehensive sample of current policy documents is obtained.The web-based search will retrieve a more purposive sample of online literature and will follow systematic procedures as outlined in Stansfield et al. (2016).Seminal literature and policy known to the researchers will also be included if not retrieved through the two search strategies.
Search criteria.To support the development of search terms and the criteria to screen studies the SPIDER (Hewitt-Taylor, 2017) (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) framework was used due to its specificity (Methley et al., 2014).Search terms were generated based on keywords determined by team members, and further developed by an overview of literature on the topics of reflective practice, collaboration between SLT and teachers as well as from educational policy in Ireland.Alongside the specific database headings, Medical Subject Headings (MeSH) and a thesaurus were also used.The table below also outlines the inclusion and exclusion criteria using the SPIDER headings.Depending on papers retrieved, criteria for inclusion and exclusion may need to be adjusted (Levac et al., 2010).

Selection process
A sample initial search string is shown in Table 2 to guide the electronic database search.This string will continue to be developed iteratively as the search progresses (Levac et al., 2010).Once the electronic database, web-based search strategies have been completed snowballing techniques will be applied.
To support the clear reporting of the search strategy procedure, an adapted version of the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) (Moher et al., 2009) will be used to represent the integrative review process.
The final citations and literature will be uploaded to Endnote software and the duplicate citations removed.Database literature will be screened first by two reviewers (JM; first author & BF; therapists from the practice context) for title and abstract, and subsequently, by full-text review (Cooke et al., 2012) in line with the study selection criteria detailed in Table 1.Some of this literature will be double screened (20%), both by title and abstract as well as full text, to ensure the transparency of the study selection process.If opinions differ regarding the inclusion of any screened literature a discussion will take place to establish consensus.A third reviewer (AG; second author) will also be available to help facilitate a final decision if an agreement cannot be reached.All steps and decisions related to this process will be documented.

Quality appraisal and data extraction
The final papers will be read in-depth several times by the first author (JM) to facilitate initial data extraction.The date of the study, author(s) as well as the sample population or context will be extracted from all included literature.Additional data extracted will vary depending on the literature type; empirical, review study, theoretical etc.For example, data extracted from theoretical literature will focus on the theories or models of reflection referenced, constructs and pathways of these theories and disciplinary origins.Data extracted from empirical literature may include information about the study design and a description of how reflection was be used.To support this process, data extraction frameworks for each literature type will be developed based on those proposed by the Joanna Briggs Institute and trialled on 5-6 papers and pieces of policy before applying broadly to all literature included in this study.
Literature included in the final synthesis will also be appraised for quality.The appraisal tool selected will be determined by the literature, likely calling for the use of different tools.The mixed method appraisal tool (M-MAT) (Hong et al., 2018) will be used to assess the methodological quality of empirical research.This is a validated tool that allows for the appraisal of qualitative, quantitative and mixed-method studies (Gallagher et al., 2019).The quality of theoretical literature will be ascertained/appraised using a tool based on the 'Joanna Briggs Institute (JBI) Checklist for 'text and opinion' (Johanna Briggs Institute -Critical Appraisal Tools).
All literature will be critically appraised independently by two reviewers.Appraisal will give consideration to how the interests of different stakeholders are represented in the literature.Reviewers will also recognise the importance of critically reflecting on the contextual positioning of the authors of primary research being analysed.Appraisal decisions will be recorded and the reason for exclusion reported.Where there is a lack of agreement, the involvement of a third reviewer will be called upon.Studies which do not adequately meet the appraisal criteria will be discarded.

Analysis
Content analysis, using the Nvivo computer software, will be used to analyse the extracted data in an attempt to describe and quantify the phenomenon (Downe-Wamboldt, 1992;Krippendorff, 1980;Sandelowski, 1995) of reflection across the speech and language therapy and educational contexts.To facilitate iterative comparison and interpretation, data extracted will be reduced in accordance with a reflection framework.
While theories about the phenomenon of reflection, and frameworks for its application, exist in both the educational and speech therapy contexts, little or fragmented knowledge exists about reflection occurring between these professionals when working together.In the selection of a framework, the author considered the context in which reflection between teachers and SLTs is most likely to occur.Hence, the lenses of reflection proposed by Stephen Brookfield often used in educational contexts, will guide analysis.
Within his Lens theory, Brookfield (1995) promotes reflecting on practice (work/life experiences) through other lenses, not only from our own perspective but from multiple perspectives, including reflecting on theory.Brookfield also calls attention to the importance of emotions in the process of reflection, which is a limitation identified in the work of earlier theorists.However, Lens Theory is not without its own limitations.It does not take into consideration the context of the practitioner and it lacks the explicit link of reflection for future.Brookfield also appears to see all teaching and learning taking place in the classroom and does not consider the more informal settings for teaching and learning.As collaboration between the professions of SLT and teachers takes place primarily in the educational setting, the concepts or lenses of Brookfield's framework will be used to create a strict categorisation matrix for deductive analysis.This framework will be trialed on a number of papers initially, before applying to the final collection of literature, which will then be reviewed for content and coded for reference to these lenses in the description of or engagement with reflection.There is the potential that new concepts could be derived from the data due to the novel nature of considering co-reflection between teachers and SLT.The data that do not fit with Brookfield's lenses will also be considered, with a view to creating new concepts using an inductive analysis process.
It is anticipated that the results from this analysis will be represented in a visual way.This visual representation will depict or adapted framework will also allow for navigation of some of the identified limitations to Lens Theory.
Addressing rigour will be an essential aspect when conducting this integrative review.To ensure this research can be considered reliable, detailed descriptions of the literature search, quality appraisal and analysing process will be given when reporting results along with the use of appendices and tables to demonstrate links between the data and results (Polit & Beck, 2004).The researcher will also be aware of issues related to combining empirical and theoretical reports.During analysis, consideration will be given to how the primary researcher's contextual positioning (an SLT working in education) may influence the understanding derived from evidence in the literature.Any unavoidable bias will be acknowledged in the limitations of the final study.

Discussion
From reviewing the literature to date, it appears that this will be the first integrative review seeking to synthesise what is shared and what is different in terms of how speech and language therapists and educators engage with reflection in their practice.The findings of this review will be relevant for researchers, practitioners and policymakers working towards truly collaborative relationships in education.This review will also contribute to the growing body of literature regarding SLT and teachers working in collaboration with those who have SLCN (Ebbels et al., 2019;Gascoigne, 2006;McCartney, 2002;McKean et al., 2017;Starling et al., 2012).It also seeks to contribute to the literature surrounding best practice for inclusive education by developing a framework for collaborative reflection.Adding to the research knowledge in this area will simultaneously reduce research waste by synthesising and conceptualising available evidence that can be used to describe the phenomenon of reflection amongst and between these professionals.

Presentation of findings
In order to disseminate the findings from this research, a review paper will be written for publication in a peer reviewed journal such as Journal of Language, Speech and Hearing Services in Schools (LSHSS) or the Journal of Interdisciplinary Studies in Education (JISE).Opportunities to disseminate at conferences will also be sought providing an opportunity to share knowledge and findings on this topic with a range of professionals, outside of speech and language therapy.Conferences may also provide the opportunity to network with teachers and practitioners to establish the value other professions place on collaborative reflection as a way to enhance practice for inclusive education.

Study status
The research question, aims and objectives are now soundly developed, along with the research design.Search terms have been developed as illustrated in this protocol and will continue to be iteratively developed throughout the literature search phase.Inclusion and exclusion criteria have been determined for literature retrieved.Similar to the development of search terms, inclusion and exclusion criteria will be informed by the search process.Methods for appraising literature have been noted, as well as methods for extraction, analysis and data synthesis.The database and web-based search phases of this research are almost complete.Screening and appraisal of literature will shortly commence followed by data extraction.
McKean C, Law There are a few minor issues that could be addressed to strengthen the protocol: In the abstract the authors mention that 'the method of qualitative evidence synthesis will be an integrative review'.This is a bit confusing.Qualitative evidence synthesis is a method in and of itself and in the Protocol itself it is clear that an integrative review will be conducted.Further clarification is required. 1.
In the Introduction, the authors outline some barriers to co-practice in paragraph two -I wonder is it worth also mentioning other barriers beyond relationships, shared language and power dynamics such as culture differences and more 'meso' level barriers.Even though this protocol will be focusing more on the individual level, it is worth acknowledging the wider context too.

2.
In paragraph 3 of the Literature Review, the authors argue that communication is a potential solution -do they mean reflective practice is a potential solution?Or could the authors elaborate on what communication means in this context? 3.
There a few small typos that could be addressed e.g., therapy missing on page 3 (in the second last paragraph) and on page 4 should be Meta-Analysis.

4.
Is there a rationale for excluding dissertations/theses from inclusion? 5.
I wish the authors the best of luck and look forward to reading this review when it has been completed.The aims and purposes underpinning the protocol presented for this integrative review of 'reflective practice across speech and language therapy and education' have been clearly articulated, soundly argued and justified.Causal factors which may challenge effective co-practice such as reciprocal relationships and power dynamics have been identified as well as some potential solutions e.g., communication processes and the use of reflection to forge new professional identities within novel working contexts.The main aim has been translated into four well-focused research objectives in the quest to determine whether a shared understanding of reflective practice exists between health and education so as to inform the development of a framework for collaborative reflective practice.

Is
Overall, the research design is appropriate for the purposes intended and draws upon the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) for guidance which importantly, as the authors acknowledge, does allow for integration of different types of knowledge about practice-based contexts emanating from the diverse literature base which includes theory, policy and empirical studies.There are however some areas which might benefit from further clarification or review by the team: Search terms in Table 1 for the 'sample' might include initial teacher education and preservice teachers; and for 'phenomenon of interest' might also incorporate collaborative communication and reflexivity given the objectives behind the review.

○
In the pursuit to capture a comprehensive and purposeful sample through the search strategy I find it curious that theses (especially doctoral theses given that these must demonstrate Level 8 FHEQ descriptors) are situated within the exclusion criteria…such works do attract significant specialist scrutiny and peer review: many are unpublished but contribute immensely to the grey literature available.

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Although highly appropriate frameworks (e.g., M-MAT and JBI) have been identified to appraise the quality and rigour of the literature under review, particularly in the case of empirical studies and primary research, when appraising 'the interests of different stakeholders' and 'contextualising the positioning of the authors' I wonder whether Guba and Lincoln's criteria for establishing 'trustworthiness of the human instrument' in qualitative research might add further weight when examining the evidence base.

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There appears to be an anomaly between the paper and Figshare insofar as data synthesis on the checklist excludes any reference of how quantitative data is to be analysed yet the paper makes explicit reference to content analysis, using Nvivo to 'describe and quantify the ○ phenomenon' (page 6)…although authors do offer an explanation of how Brookfield's (1995) Lens theory will initially guide the analysis it is not wholly transparent how the Nvivo computer software is to be used…if not for analysis then perhaps the management of data?Overall, the paper is scientifically sound and authors have provided sufficient and very explicit details of the methods employed to enable others to assess and replicate the protocol.There are minor lapses in sentence structure which would benefit from further editorial work.This is an exciting research enterprise which has great potential to contribute new knowledge to, and practical applications within, the field of speech and language therapists working collaboratively with teachers to ensure inclusion for all our students, and more specifically for those with speech, language and communication needs (SLCN).
Is the rationale for, and objectives of, the study clearly described?Yes

Are sufficient details of the methods provided to allow replication by others? Yes
Are the datasets clearly presented in a useable and accessible format?Not applicable Competing Interests: No competing interests were disclosed.
Reviewer Expertise: Reflective practice for professional development in teacher education; Social justice, equity and inclusion; Ethics in educational research I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.
pathology & audiology.The initial approach to the question using qualitative methods is appropriate.I did wonder about the emphasis on communication as a way to connect reflection rather than simply a focus on reflection, but this is a very minor point.Just prior to the research aims, the statement about reflective practice in health and education surprised me, only because the project focused on speech-language pathology and education specifically.I did wonder why the project was limited to just these fields, as it seems possible that other professions across health and education may inform thinking about the selection of a reflection framework.
Is the rationale for, and objectives of, the study clearly described?Yes

Is the study design appropriate for the research question? Yes
Are sufficient details of the methods provided to allow replication by others?Yes Are the datasets clearly presented in a useable and accessible format?

Not applicable
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: language disorder, working memory, practice-based research I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.
the rationale for, and objectives of, the study clearly described?YesIs the study design appropriate for the research question?YesAre sufficient details of the methods provided to allow replication by others?YesAre the datasets clearly presented in a useable and accessible format?Not applicableCompeting Interests: No competing interests were disclosed.Reviewer Expertise: Childhood speech, language and communication needs; qualitative research; collaborative practice I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.Reviewer Report 23 June 2021 https://doi.org/10.21956/hrbopenres.14396.r29351© 2021 Zwozdiak-Myers P.This is an open access peer review report distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Paula Zwozdiak-Myers School of Education, Brunel University London, London, UK

Table 2 .
Search string. is shared and what is different about how SLTs and teachers reflect.It is predicted that this visual will either build upon the framework of reflection posed by Stephen Brookfield or will propose a new framework for collaborative reflection within the educational context.The development of a new what

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